title: Correlation of plasma 25-hydroxyvitamin D levels with severity of primary hyperparathyroidism and likelihood of parathyroid adenoma localization on sestamibi scan.
abstract: OBJECTIVE
  To determine the relationship between preoperative plasma 25-hydroxyvitamin D (25[OH]D) levels and severity of primary hyperparathyroidism (PHPT) and to explore whether presurgical 25(OH)D levels could predict the likelihood of positive results on technetium Tc 99m sestamibi scintigraphy.
  
  
  METHODS
  Retrospective analysis.
  
  
  METHODS
  Tertiary university referral center.
  
  
  METHODS
  A total of 421 consecutive patients underwent preoperative sestamibi scintigraphy and parathyroid exploration. Patients with cholecalciferol (vitamin D) deficiency, defined as plasma levels lower than 25 ng/mL, were compared with patients having no vitamin D deficiency. We explored the relationship between 25 (OH)D levels and intact parathyroid hormone (iPTH) levels, alkaline phosphatase (ALKP) levels, adenoma weight, binary sestamibi scan results, and postoperative serum calcium levels (at 1 week and 6 months).
  
  
  METHODS
  We hypothesized that severity of hypovitaminosis D would correlate with severity of PHPT and predict the likelihood of a positive finding on sestamibi scan.
  
  
  RESULTS
  Concentrations of iPTH and ALKP and parathyroid adenoma weight were significantly higher in patients with lower 25(OH)D levels (P < .01 for all). Patients with hypovitaminosis D had a greater percentage decrease in serum calcium levels 1 week and 6 months postoperatively (P < .05). Median 25(OH)D levels were lower in patients with positive sestamibi scan results (P < .001).
  
  
  CONCLUSIONS
  Patients with hypovitaminosis D present with more advanced indices of PHPT. Parathyroid sestamibi scanning is more likely to show positive results for this subset of patients who may then benefit from sestamibi scan-directed surgical intervention.
authors.affiliation: Division of Endocrine and OncologicalSurgery, Johns Hopkins School of Medicine, Baltimore, MD 21287-0910, USA.
authors.forename: Emad
authors.initials: E
authors.lastname: Kandil
authors.forename: Anthony P
authors.initials: AP
authors.lastname: Tufaro
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Carson
authors.forename: Frank
authors.initials: F
authors.lastname: Lin
authors.forename: Helina
authors.initials: H
authors.lastname: Somervell
authors.forename: Tarik
authors.initials: T
authors.lastname: Farrag
authors.forename: Alan
authors.initials: A
authors.lastname: Dackiw
authors.forename: Martha
authors.initials: M
authors.lastname: Zeiger
authors.forename: Ralph P
authors.initials: RP
authors.lastname: Tufano
mesh_terms: D000236:Adenoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000097:blood / Q000000981:diagnostic imaging* / Q000628:therapy; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D016105:Parathyroidectomy / Q000379:methods; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D011336:Probability; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D017256:Technetium Tc 99m Sestamibi; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood; D014808:Vitamin D Deficiency / Q000175:diagnosis* / Q000453:epidemiology
chemical_list: D010281:Parathyroid Hormone; D014807:Vitamin D; D017256:Technetium Tc 99m Sestamibi; C104450:25-hydroxyvitamin D